Wednesday, December 3, 2014

Week 28 Update

So for the past three weeks I've been on carb-lock down.  Knowing that increased insulin usage has a direct relationship with increased consumption of calories (chasing lows) and fat storage (gee wiz, thanks diabetes), my endocrinologist and I agreed that I would try to cut my insulin use down to the lowest possible rate so as to curb my pregnancy weight gain. Attempting to operate on exclusively my basal dose without bolusing additional insulin to cover food intake, I've pretty much cut carbohydrates completely from my diet with the exception of my guilty pleasure of daily gummy vitamins and one, much needed and nonnegotiable, cup of coffee.  So eating three three-egg and cheese omelets a day for the past three weeks, you can imagine both the success and the frustration I've had with this "diet." 

On one hand, my insulin use is way down and not only has my weight gain stopped, but I've managed to drop several pounds.  At first I was surprised when my pump began to initiate its "auto off" function during the day (this happens only when I haven't actively programmed it for ten hours), but in looking at my how my daily usage averages have dropped over the last month it's not so surprising -- I've gone from a minimum of 55 units daily to a maximum of 32 units daily!  While the numbers on the scale aren't quite so dramatic, which is a good thing, I am also pleased that the home scale is now reading five pounds less than it did at my week 25 check up and that, thank goodness, puts me back under the 35 pound weight gain maximum that I've been advised to maintain.  The unfortunate other hand of this equation, however, is that I am beyond sick of eggs.  Come February and Baby's arrival, I don't know if I even want there to be eggs in the refrigerator as merely an ingredient let alone as a ptotential food source... ug!

Anyway, hovering at right about 30 pounds of maternal weight gain (which is still about ten pounds more than what I ought to be at this point in the pregnancy), I was feeling a bit more confident headed into the week 28 follow up we had today with the perinatologist.  Knowing that my weight and baby's weight are not necessarily linked,  however, I held my breath out of sheer anxiety as the sonographer measured and clicked, measured and clicked, measured... lingered... measured again... clicked.   

"Well, your baby is measuring about two weeks farther along at 3 pounds 4 ounces," she states with an impressed air. 

Thinking back to the beginning of the pregnancy when our dates weren't lining up with the size of the fetal yolk sac causing the MFM to move our due date back from February 8 to February 21, I inquired of the sonographer if that might be why we're seeing him grow much, much more quickly than he should. 

"No," she said with certainty. "Early sonograms are very accurate - within three or four days - for gestational age.  You'll have to talk to Doctor Nies about his weight."  

Finding this information to be far from comforting given our knowledge that the average baby should weigh no more than 2 pounds 2 ounces at 28 weeks, I braced myself for more bad news as HB, GV and I sat down for our consultation. 

"How are you?"  Dr Nies asked.

"Stressed beyond belief," was the only honest answer. 

Being the nicest, most comforting of the practitioners at this particular office, Dr. Nies kept her kiddie gloves on for our conversation as she dove into my chart and looked at the results of the sonogram and compared them to my triage stats.  Upon seeing my decreased weight and confirming that I was in fact still eating, she gently moved on to explain that her primary concern at this point in the pregnancy is not Baby's above average weight, but that my amniotic fluid levels are elevated. So while she simultaneously assuaged my concerns that a c-section for macrosomia may not be necessary (that will be contingent on Baby's weight being above 10, maybe even 9, pounds in several more weeks),  the high amniotic fluid index (AFI) reading of 23.1 requires a diagnoses of mild polyhydramnios.  Stating we'd keep an eye on it but to call immediately if I get "unusually bigger" or experience more contractions (a regular happening of late), we left the appointment with both me and my uterus feeling irritable. 

As polyhydramnios is a brand new complication for the books (oh joy), I promptly began my homework upon reaching the car.  Playing a sick and twisted game of chicken and the egg, the condition could be a result of my diabetes (not likely given my HgA1C) or it could be a bi-product of the macrosomia OR, to keep things interesting, the macrosomia could be a result of the polyhydramnios and exacerbated by structural complications we are currently unaware of in the fetus.  Charming, right? Regardless of cause, however, the presence of even a mild case of polyhydramnios - and let's pray it doesn't elevate itself to a moderate or severe case - on my already high risk case makes the rest of this pregnancy more complicated and more prone to additional issues than before.  Polyhydramnios is associated with: 
  • Placental abruption (because I needed to be at more risk for that...)
  • Pre-term labor and rupture of membranes
  • Umbilical cord-prolaps
  • Mandatory C-section
  • Still birth
  • Post-delivery hemorrhaging due to the excessive size of the uterus during pregnancy

So... that's not good. Unfortunately there isn't anything that I can do above and beyond what I am already doing to prevent either macrosomia or polyhydramnios.  I can keep my diabetes under tight management - check - and I can work to keep my weight gain below 35 pounds for the pregnancy - check, thus far at least.  Beyond that, the outcome is entirely in God's hands and at the whim of my perinatologists when and if things progress one way or another.   In the mean time, I'll just continue to worry and eat my omelets...  someone have pancakes and a couple Christmas cookies for me, will ya? 

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